Laparoscopic surgery for rectal cancer, specimen extraction: transanal or transabdominal?

BACKGROUND: Comparison of natural orifice specimen extraction (NOSE) and transabdominal specimen extraction (TASE) in colorectal surgery remains controversial. Herein, we aimed to perform a retrospective analysis on surgical outcomes of NOSE and TASE at three hospitals in east of Iran. METHOD: Consecutive locally advanced rectal adenocarcinoma patients who underwent laparoscopic surgery using either NOSE or TASE from 2011 to 2017 were recruited. These patients were followed-up till 2020. Data, including postoperative complications, long-term overall and recurrence-free survival were analyzed retrospectively. RESULTS: 239 eligible patients were included in this study. 169 (70.71%) patients underwent NOSE, and 70 (29.29%) patients underwent TASE. Although this study has achieved similar outcomes in terms of overall and recurrence-free survival, metastasis, circumferential margin involvement as well as complications of intra-operative bleeding, obstruction, anastomosis-fail, rectovaginal-fistula in women and pelvic collection/abscess in both groups, we observed higher rates of locoregional recurrence, incontinency, stenosis and the close distal margins involvement in NOSE group and also obstructed defecation syndrome in TASE cases. CONCLUSION: According to our findings, NOSE laparoscopic surgery showed significantly higher incontinency, impotency, stenosis and involvement of the close distal margins rates. Nevertheless, considering the similarity of long-term overall and recurrence-free survival, metastasis, circumferential margin involvement, NOSE procedure is still could be considered as a second choice for lower rectal adenocarcinoma patients.

Comparison of Perceived Self-efficacy, Benefits, and Barriers of Hypertension Control between Male and Female Patients Referred to Rajaie Cardiovascular Medical and Research Center in Tehran.

Background: Hypertension is a health problem. The purpose of the present study was to compare perceived self-efficacy, benefits, and barriers of hypertension control between male and female patients. Methods: This cross-sectional study was carried out on 400 patients referred to Rajaie Cardiovascular Medical and Research Center in Tehran from August 2020 through March 2021. The convenience sampling method was used. The data collection tools consisted of a digital sphygmomanometer, a demographic form, and a researcher-made questionnaire of perceived benefits, barriers, and self-efficacy of hypertension control, whose validity and reliability were obtained. Results: The mean age of the male and female patients was 54.02±12.93 years and 56.48±12.10 years, respectively. The mean score of perceived barriers in women was lower than that in men, and the mean perceived self-efficacy in women was higher than that in men (P<0.001). According to the regression test, history of smoking in men and family history of hypertension and age in women were predictors of perceived benefits. Further, occupation and history of smoking in men and education level, family history of hypertension, and history of smoking in women were predictors of perceived barriers. Additionally, marital status, education level, and disease duration in men and education level, family history of hypertension, history of smoking, and age in women were predictors of perceived self-efficacy (P<0.050). Conclusion: In men, the mean score of perceived barriers was higher and the mean score of perceived self-efficacy was lower. Additionally, the predictors of each of these perceptions were determined.

Investigating the relationship between occupational exposure to nanomaterials and symptoms of nanotechnology companies' employees.

PURPOSE: The increasing use of nanomaterials in academic and industrial environments has raised concerns about the potential effects of these materials on human and the environment. Researches have shown that occupational exposure to nanomaterials can affect employees' health. Many companies are active in the field of nanotechnology in Iran. Therefore, this study was designed and conducted to investigate the relationship between the symptoms of these companies' employees and exposure to nanomaterials. METHODS: The study was conducted among employees of 52 nanotechnology companies in Tehran. For this study, the employees of these companies were categorized in two groups: "exposed" and "non-exposed" to nanomaterials. Data collection tools included the NanoTool method form and a nonspecific symptom questionnaire designed and validated by a team of 19 experts in various fields. Finally, data were analyzed using SPSS.22 software. RESULTS: The results showed that the frequency of cutaneous (such as roughness, itching and redness), respiratory (such as cough, sneezing, and burning throat) and ocular (such as burning, itching and redness) symptoms were higher among the exposed workers to nanomaterials. Examination of the correlation between these symptoms in the two studied groups showed that symptoms with high frequency have a significant relationship with exposure to nanomaterials. CONCLUSIONS: Given the high prevalence of some symptoms among the employees of the studied companies and their association with exposure to nanomaterials, it seems necessary to take control measures to reduce the exposure of employees to nanomaterials and consequently reduce the Investigated symptoms.

Trend Analysis of HIV/AIDS Burden in Iran: Results from the Global Burden of Disease 2017 Study.

Background: Despite global efforts, human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) is still one of the major public health problems in the entire world. In this context, assessing the burden of this disease in different parts of the world is of great importance. In this study, we aimed to investigate the trends of HIV/AIDS incidence and mortality in Iran during 1990 and 2017. Methods: The HIV/AIDS burden data, including the age-standardized incidence rate (ASIR) and the mortality rate (ASMR), was extracted from the Global Burden of Diseases 2017 study for the total Iranian population and by gender from 1990 to 2017. The trend analysis was performed using joinpoint regression modeling approach. Results: The obtained results showed that in 2017, the HIV/AIDS ASIR and ASMR were, respectively, more than 12 and 10 times of these rates in 1990. Also, the estimated average annual percent change (AAPC) was 9.8% and 8.7%, respectively for the ASIR and the ASMR. In this period, women have experienced a sharper slope of ASIR and ASMR trends compared with Iranian men. Conclusion: The increasing trend of HIV/AIDS burden is a serious alarm for the Iranian health policymakers. To achieve the United Nations Programme on HIV and AIDS goals, there is an urgent need for an efficient national action plan that breaks the HIV/AIDS taboo in the society, promote access to HIV testing and prevention facilities, especially among the key populations, and provide care and treatments for all infected people.

Controlling the anxiety in Iranian pregnant women at risk of preterm labor by undergoing the counseling group intervention.

OBJECTIVE: The effect of a new, structured group training program on the anxiety reduction in Iranian pregnant women at risk of preterm labor (PTL) was assessed. DESIGN: A randomized controlled clinical trial. SETTING: The prenatal care center in the Gynecology Clinic of University Hospital. POPULATION: 72 Iranian pregnant women at risk of PTL with a gestational age of 24-28 weeks. METHODS: Several trained research nurses presented group educational counseling sessions for 6 weeks based on the integration of psychological instructions and interactive lectures for the intervened group (n = 36). Pregnant women in the control group (n = 36) only received routine pregnancy care. MAIN OUTCOME MEASURES: The completion of pregnancy-related anxiety questionnaire (PRAQ) for Iranian pregnant women at risk of PTL in the intervention (before and after 6-week counseling, and 1-month post-counseling) and control (before, and on the 6th and 10th week after the study) groups. RESULTS: There was a significant difference in the mean anxiety score between the intervention (3.45 ± 0.75) and control (3.01 ± 0.34) groups before the group educational counseling sessions. After this intervention, a significant reduction in the mean anxiety scores of intervened pregnant women (2.48 ± 0.32) compared to the control (2.68 ± 0.81) was found. This decrease in mean anxiety score after the 1-month post-counseling was more pronounced than the 6th week after the study onset (P < 0.001). Low anxiety scores in the intervention group over time were also maintained. CONCLUSIONS: Implementing the group educational counseling sessions is recommended as a complementary, effective, and noninvasive intervention to efficiently control the anxiety in pregnant women at risk of PTL.

Human platelet antigens polymorphisms; association to the development of liver fibrosis in patients with chronic hepatitis C.

Recently, human platelet antigens (HPAs) polymorphisms are found to play a role in susceptibility to hepatitis C virus (HCV) infection and fibrosis progression. The aim of the current study was to evaluate the possible association between the HPAs polymorphisms with liver fibrosis progression in HCV patients. HPAs polymorphisms genotyping was performed in HCV patients (n = 71) by Sequence-specific primers-polymerase chain reaction. Fibrosis progression was evaluated using the Metavir scoring system and liver biopsy, and the patients were assigned to two groups, namely, G1 (n = 35) that included patients with F1 (portal fibrosis without septa) or F2 (few septa) and G2 (n = 36) that comprised patients with F3 (numerous septa) or F4 (cirrhosis). The data analyses were performed using Pearson's χ2 test. The genotype frequency of HPA-3ab was significantly higher in G1 patients than in G2 patients (P = 0.015). No statistically significant differences were found between the patient groups (G1 and G2) regarding the distributions of the allelic and genotypic frequencies of the HPA-1, -2, -4, -5, and -15 systems. Multivariate logistic regression showed an independent association between the genotype HPA-3aa/BB and severe fibrosis (F3-F4), when compared with genotype HPA-3ab, independent of the viral genotype, high alanine transaminase, sex, age, time of infection, diabetes, and high cholesterol as risk factors. The present study suggested that the HPA-3ab genotype could be noticed as a potential protecting factor against hepatic fibrosis. Therefore, the antigenic variation of integrins might be considered as a part of the coordinated inflammatory process involved in the progression of liver fibrosis.

A comparison of the effect of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth in adults.

Introduction: There is no agreement on how the hands are positioned in cardiopulmonary resuscitation (CPR). In this study, the effects of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth are compared. Methods: In this observational simulation, the samples included 62 nursing students and emergency medicine students trained in CPR. Each student performed two interventions in both basic and advanced situations on manikins and two positions of dominant hand on non-dominant hand, and vice versa, within four weeks. At each compression, the chest compression depth was numerically expressed in centimeter. Each student was assessed individually and without feedback. Results: The highest mean chest compression depth was related to Basic Cardiovascular Life Support (BCLS) and the position of the dominant hand on non-dominant hand (5.50 ± 0.6) and (P = 0.04). There was no statistically significant difference in the basic and advanced regression variables in men and women except in the case of Advanced Cardiovascular Life Support (ACLS) with dominant hand on non-dominant hand (P = 0.018). There was no significant difference in mean chest compression during basic and advanced cardiovascular life support in left- and right-handed individuals (P = 0.09). Conclusion: When the dominant hand is on the non-dominant hand, more pressure with greater depth is applied.

Effect of saffron (Crocus sativus L.) and endurance training on mitochondrial biogenesis, endurance capacity, inflammation, antioxidant, and metabolic biomarkers in Wistar rats.

We aimed to evaluate the effect of saffron (Crocus Sativus L.) treatment on endurance capacity, mitochondrial biogenesis, inflammation, antioxidant, and metabolic biomarkers in Wistar rats. Forty male rats were allocated equally into four groups: Saffron, Exercise and Saffron, Exercise and Placebo, and Placebo. Endurance training was accomplished on a specified rodent motor-driven treadmill. Running to fatigue test and also metabolic and molecular indices were measured after eight weeks of intervention. mtDNA copy number and NRF-1 gene expression increased significantly in the Ex + S group compared to the exercised and control group (p < 0.05). Endurance capacity time increased in the Ex + S group compared to the Ex group (p < 0.05). Malondialdehyde, CPK, AST, and IL-6 decreased and antioxidant parameters including Glutathione peroxidase and Glutathione increased in the Ex + S group compared to exercised rats (p < 0.01). Saffron enhanced mitochondrial biogenesis, decreased oxidative stress, inflammation, and modulated metabolic biomarkers in exercised rats. PRACTICAL APPLICATIONS: The influence of potential nutrient factors on exercise performance has reached much attention in recent years. Athletes require an appropriate sport supplement to reimburse their fatigue and improve their resilience. Saffron (Crocus Sativus L.) is a well-known spice in the food trade which is quite popular around the world by giving a desirable taste to food. In an experimental study, we showed that saffron extract treatment during endurance training could improve endurance capacity by modulating several metabolic and genomic factors. Therefore, by relying on the results of this study and the positive effects of saffron published in previous studies, saffron could be added to sport beverages and supplements to enhance an athlete's performance.

Comparison of health behaviors among students of Iranian medical and human sciences universities.

BACKGROUND AND AIM: Health risk behaviors are major and threatening problems of societies. The aim of this study was to determine and compare health behaviors among students of Iranian medical and human sciences universities. METHODS: In this cross-sectional study, 570 senior medical and human sciences students of Ilam universities (Ilam, Iran) were selected during the period between October 2015 and October 2016, using the stratified random sampling method. The research tool was the self-assessment health questionnaire which consists of personal information, understanding the concept of health and health behaviors. Descriptive statistics and Mann-Whitney U, independent samples t-test and Pearson product-moment correlation tests were used in SPSS version 16. RESULTS: The scores obtained by both groups of medical sciences and human sciences students were low. There was no significant relationship between field of study and the score of understanding the concept of health (p=0.289); but the relationship between field of study and the score on health behaviors (p=0.001) and between health behaviors and understanding the concept of health were significant for both the students of medicine (r=0.259, p=0.01) and the students of human sciences (r=0.493, p=0.001). CONCLUSION: Students' health behaviors were not at a desirable level. Conducting interventions in the form of research projects have been recommended.

Comparison of human umbilical cord blood processing with or without hydroxyethyl starch.

BACKGROUND: Umbilical cord blood (UCB) processing with hydroxyethyl starch (HES) is the most common protocol in the cord blood banks. The quality of UCB volume reduction was guaranteed by minimum manipulation of cord blood samples in the closed system. This study aimed to analyze and compare cell recovery and viability of UCB processed using the Sepax automated system in the presence and absence of HES. STUDY DESIGN AND METHODS: Thirty UCB bags with a total nucleated cell (TNC) count of more than 2.5 × 109 were divided in two bags with equal volume. HES solution was added to one bag and another was intact. Both bags were processed with the Sepax. To determine cell recovery, viability, and potential of colony-forming cells (CFCs), preprocessing, postprocessing, and thawing samples were analyzed. RESULTS: The mean TNC recovery after processing and after thaw was significantly better with the HES method (p < 0.01 for the postprocessing step and p < 0.05 for the postthaw step). There were no significant differences to mononucleated cells (MNCs) and CD34+ cell recovery between the two methods after processing and after thaw. TNC and MNC viability was significantly higher without HES after processing and after thaw (p < 0.01). The results of the CFC assay were similar for both methods after processing and after thaw. CONCLUSION: These results showed that processing of UCB using the Sepax system with the without-HES protocol due to the lower manipulation of samples could be used as an eligible protocol to reduce the volume of UCB.

Factors affecting survival of patients with oesophageal cancer: a study using inverse Gaussian frailty models.

INTRODUCTION: Oesophageal cancer is one of the most common causes of cancer mortality in developing countries, including Iran. This study aimed to assess factors affecting survival of patients with oesophageal cancer using parametric analysis with frailty models. METHODS: Data on 359 patients with oesophageal cancer was collected from the Babol Cancer Registry for the period 1990-1991. By 2006, the patients had been followed up for a period of 15 years. Hazard ratio was used to interpret the risk of death. To explore factors affecting the survival of patients, log-normal and log-logistic models with frailty were examined. The Akaike Information Criterion (AIC) was used for selecting the best model(s). Cox regression was not suitable for this patient group, as the proportionality assumption of the Cox model was not satisfied by our data (p = 0.007). RESULTS: Multivariate analysis according to parametric models showed that family history of cancer might increase the risk of death from cancer significantly. Based on AIC scores, the log-logistic model with inverse Gaussian frailty seemed more appropriate for our data set, and we propose that the model might prove to be a useful statistical model for the survival analysis of patients with oesophageal cancer. The results suggested that gender and family history of cancer were significant predictors of death from cancer. CONCLUSION: Early preventative care for patients with a family history of cancer may be important to decrease the risk of death in patients with oesophageal cancer. Male gender may be associated with a lower risk of death.

Family history of the cancer on the survival of the patients with gastrointestinal cancer in northern Iran, using frailty models.

BACKGROUND: Gastrointestinal (GI) tract cancer is one of the common causes of the mortality due to cancer in most developing countries such as Iran. The digestive tract is the major organ involved in the cancer. The northern part of the country, surrounded the Caspian Sea coast, is well known and the region with highest regional incidence of the GI tract cancer. In this paper our aim is to study the most common risk factors affecting the survival of the patients suffering from GI tract cancer using parametric models with frailty. METHODS: This research was a prospective study. Information of 484 cases with GI cancer was collected from Babol Cancer Registration Center during 1990-1991. The risk factors we studied are age, sex, family history of cancer, marital status, smoking status, occupation, race, medication status, education, residence (urban, rural), type of cancer, migration status (indigenous, non-native). The studied cases were followed up until 2006 for 15 years. Hazard ratio was used to interpret the death risk. The effect of the factors in the study on the patients survival are studied under a family of parametric models including Weibull, Exponential, Log-normal, and the Log-logistic model. The models are fitted using with and without frailty. The Akaike information criterion (AIC) was considered to compare between competing models. RESULTS: Out of 484 patients in the study, 321 (66.3%) were males and 163 (33.7%) were females. The average age of the patient at the time of the diagnosis was 59 yr and 55 yr for the males and females respectively. Furthermore, 359 (74.2%) patients suffered from esophageal, 110 (22.7%) patients recognized with gastric, and 15 (3.1%) patients with colon cancer. Survival rates after 1, 3, and 5 years of the diagnosis were 24%, 16%, and 15%, respectively. We found that the family history of the cancer is a significant factor on the death risk under all statistical models in the study. The comparison of AIC using the Cox and parametric models showed that the overall fitting was improved under parametric models (with and without frailty). Among parametric models, we found better performance for the log-logistic model with gamma frailty than the others. Using this model, gender and the family history of the cancer were found as significant predictors. CONCLUSIONS: Results suggested that the early preventative care for patients with family history of the cancer may decrease the risk of the death in the patients with GI cancer. The gender appeared to be an important factor as well so that men experiencing lower risk of death than the women in the study. Since the proportionality assumption of the Cox model was not held (p = 0.0014), the Cox regression model was not an appropriate choice for analysing our data.

Prognostic factors for the survival of patients with esophageal cancer in Northern Iran.

BACKGROUND: Esophageal cancer is the 8(th) most common cancer and the 6(th) leading cause of cancer-related death, worldwide. In Iran, the high incidence rates of this type of cancer have been reported from the Caspian Sea region. This study aimed at assessing the factors affecting survival of patients with esophageal cancer in neighbor provinces around Caspian Sea using parametric and semi-parametric models with univariate gamma frailty model. METHODS: In this study, we performed a prospective review of 359 patients presenting with esophageal cancer from 1990 to 1991. The data were obtained using the Cancer Registry information existed in Babol research center in Iran. Study participants were followed-up until 2006 for a period of 15 years. Hazard ratio was used to interpret the risk of death. The Akaike Information Criterion (AIC) was considered as a criterion to select the best model(s). RESULTS: Of the 359 patients, 225 (62.7%) were male with a mean age of 60.0 years and 134 (37.3%) were female with a mean age of 55.3 at the time of diagnosis. 1- , 3- and 5-year survival rates after diagnosis were 23%, 15% and 13% , respectively. Comparison between Cox and parametric models of AIC showed that the overall fitting was improved under parametric models. Among parametric models, the log-logistic model with gamma frailty provided better performance than other models. Using this model, we found that gender (p=0.012) and family history of cancer (p= 0.003) were significant predictors. CONCLUSIONS: Since the proportionality assumption of the Cox model was not held (p = 0.01), the Cox regression model was not an appropriate choice for analyzing our data. According to our findings, log logistic model with gamma frailty could be considered as a useful statistical model in survival analysis of patients with esophageal cancer rather than Cox and log-normal models.